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CC BY 4.0 · Journal of Coloproctology 2025; 45(03): s00451810617
DOI: 10.1055/s-0045-1810617
Original Article

Age-Related Trends in Colon Cancer Incidence

Batool Mutar Mahdi 
1   Department of Microbiology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
,
Mohammed Khalid Abbas
1   Department of Microbiology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
,
Abdullah Issam Dawod
1   Department of Microbiology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
,
Ahmed Majeed Ameer
1   Department of Microbiology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
› Author Affiliations

Funding The author(s) received no financial support for the research.
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Abstract

Introduction

Colon cancer is a malignant tumor affecting the colon, often arising from polyps. The main risk factors include age, genetics, diet, and lifestyle. It is typically characterized by rectal bleeding, altered bowel habits, and weight loss.

Objective

This study will analyze the time-based and sequential trends of age-standardized cancer incidence.

Materials and Methods

The cross-sectional retrospective study included 1204 patients diagnosed with colon cancer over a period extending from 2015 to 2025 at Medical City Hospital in Baghdad, Iraq.

Results

This cross-sectional study included 1204 patients with tumor of the colon, their age ranged from (14-95) years, mean ± Standard error mean was (55.97 ± 0.392). Males were 56.4% (680 cases) more than females 43.5% (524 cases) (P = 0.000). The majority fall within the 50-69 age group, with 26.81% (50-59) and 27% (60-69) of the total patients. The 30-39 and 40-49 age groups represent moderate portions of them, accounting for 7.81% and 18.18%, respectively. Younger age groups (10-29) have the lowest representation, making up only 5.14% of them.

Conclusion

The data suggests an aging patient with colon cancer with a higher male representation across most age groups. The highest percentages were in the 50-69 years category, while younger individuals are underrepresented. The trend of a declining male to female ratio in older age groups aligns with general demographic trends, where women tend to have higher life expectancy.


 

Keywords

colon - age - cancer

Introduction

Colon cancer is the fourth most frequently diagnosed cancer and the second significant cause of mortality in the United States. Management involves many drugs, either used alone or in combination with other approaches.[1] The prognosis of colon cancer depend on many factors like site of tumor like right side of the colon is significantly worse than that of left one, older age, histopathological type, and lymph node involvement.[2] Other risk factors like tobacco smoking, alcohol consumption, obesity, diets that low in fruits and vegetables, lack of physical activity or exercise, and lack sun exposure. Thus, a very large quantity of cancer's impact could be bettered if more people avoided these risk factors exposures.[3] Differences in the average age at cancer diagnosis are observed across many countries. The median ages at diagnosis of colorectal cancer typically increasing in low- and middle-income countries (LMICs) and decreasing in high-income countries (HICs), given relatively younger and older populations, respectively.[4] The risk of CRC increases quickly with increasing age and the incidence rates increased about 80%-100% with each five years age group until person reached fifty years of age and then 20-30% from age 55-59 years.[5] So, many screening methods used to early detection of this tumor like Serum CCSA-4 (Colon Cancer–Specific Antigen 4),[6] serum APRIL (A proliferation-inducing ligand)and CEA (Carcinoembryonic antigen),[7] CA15-3 (Cancer Antigen)[8] to decrease mortality and morbidity. The complex physiological changes occur in the aging intestinal microenvironment that are linked with an increased risk of colon cancer in older adults. Aging markedly predisposed persistent fucosylation of the apical surfaces of intestinal epithelial cells, which resulted in a favorable situation for tumor growth. Additionally, host-micro commensal interaction, which enables the dysregulation of fucosylation and helps tumor growth as patients get older. Moreover, analysis of single-cell RNA-sequencing identified different epithelial cell subtypes involved in dysregulated fucosylation in older adults. Additionally, excessive fucosylation is associated with the development of colon cancer, that age-related changes increase susceptibility to colon cancer, and that a dysbiosis in microbial diversity and metabolic changes in the homeostasis of older subjects dysregulate fucosylation levels with increased age.[9]

This study aims to analyze the time-based and sequential trends of age-standardized cancer incidence from 2015 to 2025.


 

Materials and Methods

The cross-sectional retrospective study included 1,204 patients diagnosed with colon cancer (newly diagnosed and regardless of disease stage at presentation) over a period extending from January 2015 to January 2025 at Al-Shifa Hospital in Baghdad, Iraq. The study was approved by the Scientific and Ethical Committees of Al-Kindy Medical College, Medical City Hospital (Ministry of Health) and Al-Shifa Hospital, under approval number 42598, dated December 2, 2024. Inclusion criteria included all patients identified with tumors of the colon at that period who referred to this hospital or those referred from other institutions whereas exclusion criteria applied to those with other kinds of tumors and recurrent cases. The data were collected from the records and archives of hospital (data anonymization procedures were followed) included the demographic ones that involved age, gender, address, occupation, and other sectors of the data encompassed the medical one like date of the diagnosis, histopathology, treatment type such as surgery, chemotherapy, radiotherapy, and immunotherapy. The data were stratified according to age and other variables.

Statistical Analysis

Information was collected and was directed using Microsoft Excel (2016) and SPSS (version 28), with descriptive statistics existing as frequencies, and percentages. Normality of distribution was assessed prior to using other tests. The level of significance was calculated using Student t- test and Chi Square Test. p-value less than or equal to 0.05 was significant.


 

 

Results

This cross-sectional study included 1204 patients with tumor of the colon, their age ranged from (14-95) years, mean ± Standard error mean was (55.97 ± 0.392). Males were 56.4% (680 cases) more than females 43.5% (524 cases) (P = 0.000). About 41.0% (494) from Baghdad and the rest from other provinces (58.9%) 710, and 41.5% of them were governmental occupation and others were non-governmental (58.4%) 704. [Table 1] presents the demographic characteristics of 1204 patients diagnosed with colon cancer, categorized by gender. It includes different variables such as age, sex distribution, address, and occupation, along with corresponding P-values indicating statistical significance. Regarding age distribution, mean age (X ± SEM) for males comprised 56.06 ± 0.528 years, while for females, it was 55.85 ± 0.585 years (P-value = 0.790) suggests no statistically significant difference in age between the two groups. Males (56.4%) more affected than females (43.5%) (P = 0.000). Moreover, geographic Distribution showed a larger proportion of patients (34.71% males and 24.25% females) came from provinces outside Baghdad, while 22.11% of males and 19.26% of females resided in Baghdad (P = 0.044) suggests a significant difference in geographic distribution, with more male patients from outside Baghdad. Regarding occupational status, government employees accounted for 33.72% of males but only 7.80% of females which in contrast to non-government employees were 22.75% of males and 35.71% of females (P-value = 0.000) indicates a statistically significant difference in occupational status, with more females working in non-governmental roles.

Table 1

The demographic data of the patients with cancer of the colon

Variables

Males

No. %

Females

No. %

P-value

Age (x ± SEM)

56.06 ± 0.528

55.85 ± 0.585

0.790

Sex

680 56.4

524 43.5

0.000

Address

Baghdad

262 22.11

232 19.26

0.044

Other provinces

418 34.71

292 24.25

Occupation

Goverment

406 33.72

94 7.80

0.000

Non-goverment

274 22.75

430 35.71

Total

1204

The study presents the distribution of a population based on age and gender as shown in [Table 2] and [Fig. 1]. It includes the number and percentage of male and female patients with colon cancer across different age groups. Total Population was 1,204 individuals, with the majority fall within the 50-69 age group, comprising 26.81% (50-59) and 27% (60-69) of the total patients. The 30-39 and 40-49 age groups represent moderate portions of them, accounting for 7.81% and 18.18%, respectively. Younger age groups (10-29) have the lowest representation, making up only 5.14% of them. The elderly (70 and above) constitute a significant portion, with 14.69% (70-79), 2.15% (80-89), and 0.16% (90 + ). The largest gender gap appears in the 50-59 and 60-69 age groups while the difference narrows in the older age brackets, especially among those 70-79 and 80-89 years.

Table 2

Distribution of patients with colon cancer based on age and gender

Age

Male

Female

Total No.

Total %

number

%

number

%

9≥

0

0%

0

0%

0

0%

10_19

2

0.16%

0

0%

2

0.16%

2029

28

2.32%

20

1.66%

48

3.98%

3039

50

4.15%

44

3.65%

94

7.80%

4049

116

9.63%

103

8.55%

219

18.18%

5059

184

15.29%

127

10.54%

311

25.83%

60 69

186

15.45%

139

11.54%

325

26.99%

70_79

96

7.97%

81

6.72%

177

14.69%

8089

17

1.41%

9

0.74%

26

2.15%

90≤

1

0.08%

1

0.08%

2

0.16%

Total

680

56.46%

524

43.48%

1204

100%

Zoom
Fig. 1 Distribution of patients with colon cancer based on age and gender.

 

Discussion

Colon cancer is the third most common cancer among men and women. This demographic analysis reveals that colon cancer affects more males than females. While age differences are not statistically significant, there are notable differences in geographic and occupational distribution. A higher proportion of male patients are from outside Baghdad and employed in government sectors, whereas more females are engaged in non-governmental work. The findings highlight potential sociodemographic factors influencing colon cancer prevalence. The analysis of colon cancer patients in this study reveals significant gender differences in frequency and occupational background. Males constituted a higher percentage (56.4%) of colon cancer cases compared to females (43.5%), a statistically significant finding (P = 0.000). This aligns with previous studies that suggest a higher incidence of colon cancer in males, potentially due to hormonal factor, oestrogen had a protective effect against colon cancer via gene regulation and cell signaling. It regulates the activity the activity of a class Kv channels that control ion transport function of epithelial cells of the colon, and epithelial mesenchymal transition through bi-directional interaction with Wnt/β-catenin signaling, and after menopause the risk was increased.[10] Other factors are differences in lifestyle factors, and dietary habits like lower fiber intake and consumption of red and processed meat, smoking, alcohol consumption, obesity, and genetic predisposition.[11] So, regular screenings using colonoscopy, a healthy diet, regular exercise, and reducing alcohol, and smoking can help lower the risk. The distribution of patients by geographic location indicates a higher proportion of cases from Baghdad province (41.37%) compared to other provinces in the country (58.63%), suggesting potential environmental factors or lifestyle patterns that influence disease prevalence. A similar tendency has been observed in prior epidemiological studies, highlighting urbanization and exposure to risk factors such as processed food consumption and sedentary lifestyle as contributors.[12] A striking disparity is noted in occupation, where a significantly higher number of male patients were employed in government jobs (33.72%) compared to females (7.80%), while more females were in non-governmental employment (35.71%) compared to males (22.75%) (P = 0.000). This in agreement with other study that demonstrated asbestos exposure may cause development colorectal cancer and other occupational factors, including stress levels, exposure to carcinogens, and healthcare accessibility, may play a role in these observed differences.[13] [14] These findings emphasize the importance of targeted awareness and screening programs for colon cancer, particularly for high-risk groups. According to studies, one of the most significant risk factors in colon cancer development is age, with incidence of colon cancer rising significantly, and exponentially in older age groups particularly after fifty years of age which is in accordance with results of this study, the majority of cases were diagnosed within the 50-69 age group which is 52.82% of the total while the youngest group (10-19 years) has the least representation (0.16%). According to American Cancer Society, 2022 about 90% of colon cancer occur over the age of fifty years.[15] The aging process lead to increase genetic mutation due to greater exposure to carcinogens and decrease DNA repair efficiency. Moreover, decline immune functions with aging that impairs the ability of immune cells to eradicate any abnormal cells (Immune surveulance).[16] Colon Cancer usually developed from colon polyp that need many years to progress into invasive cancer, so the older patients are more likely to develop cancer.[17] Other interesting factor is gut microbiome, older patients had less diverse mirobiome, and the balance of microbial communities may shift toward species that are pro-inflammatory and potentially carcinogenic. These microbial changes can lead to the production of metabolites that promote cancer development in the colon.[18] Other comorbidity factors like diabetes, hypertension, and drugs like non-steroidal anti-inflammatory drugs may increase the risk of development cancer.[19] Life style factors, such as low fiber diet, decrease physical activity, alcohol and smoking, continue to play a significant role in the development of colon cancer in older adults.[20] Thus, early screening using colon cleansing preparation and colonoscope done for detection colon polyp, and cancer increases with age in detection early stage cancer and improve survival rates especially in positive family history.[3] [21] This was in agreement with other reports in United States, and Europe that demonstrate older age group (50-74 years) were more liable to develop colon cancer.[22]


 

Conclusions

Age is a critical and important factor in the development of colon cancer, particularly in males older age groups more than forty years. This can be due to many biological factors, including genetic mutations, a declining immune system, and increased inflammation.

The data suggests an aging patient with colon cancer with a higher male representation across most age groups. The highest percentages were in the 50-69 years category, while younger individuals are underrepresented. The trend of a declining male to female ratio in older age groups aligns with general demographic trends, where women tend to have higher life expectancy.


 

 

Conflict of Interest

The authors report no conflict of interest.

Authors' Contributions

BMM: editing and supervision of the study; MKA: data collection, writing, statistical analysis, funding acquisition; AID: data collection, writing, statistical analysis, funding acquisition; AMA: data collection, writing, statistical analysis, funding acquisition.



Address for correspondence

Batool Mutar Mahdi, MB ChB, MSc, FICMS-Path
Department of Microbiology, Al-Kindy College of Medicine, University of Baghdad
Baghdad
Iraq   

Publication History

Received: 10 June 2025

Accepted: 21 July 2025

Article published online:
27 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Batool Mutar Mahdi, Mohammed Khalid Abbas, Abdullah Issam Dawod, Ahmed Majeed Ameer. Age-Related Trends in Colon Cancer Incidence. Journal of Coloproctology 2025; 45: s00451810617.
DOI: 10.1055/s-0045-1810617

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Fig. 1 Distribution of patients with colon cancer based on age and gender.